Superior gluteal artery perforator flap for autologous breast reconstruction: Refined surgical technique, outcomes, and patient satisfaction

BACKGROUND: Deep inferior epigastric perforator (DIEP) flaps are the gold standard for autologous breast reconstructions, but alternatives are needed when the abdomen is not optional. The superior gluteal artery perforator (SGAP) flap, using the gluteal region as donor site, is such an alternative. However, SGAP-flaps are not widely used for breast reconstructions due to technical and anatomical challenges, and potential donor site deformity. This study presents a slightly modified SGAP-flap harvesting technique for breast reconstructions aimed at optimizing outcomes and describes surgical and patient-reported outcomes.

METHODS: An observational study (retrospective and cross-sectional) was conducted by including all women who underwent SGAP-flap breast reconstruction between May 2012 and March 2024 in a high-volume cancer center. Patient and surgical characteristics, (un)planned surgical revision rates, and patient-reported satisfaction were assessed using BREAST-Q (91% response rate).

RESULTS: In total, 33 SGAP-flap breast reconstructions were performed in 26 patients. Mean ischemia time was 156 min. Four major complications (12%) requiring unplanned surgical intervention occurred, with no (partial) flap loss (i.e., 100% flap survival). Four flaps underwent planned secondary corrections (12%) of the donor site. Patient-reported donor site deformity and/or dissatisfaction was infrequent (n=2). Five patients underwent SGAP-flap on one side and DIEP-flap reconstruction contralaterally (15%), with similarly high patient-reported satisfaction and well-being scores for both sides.

CONCLUSIONS: High patient-reported satisfaction, and low complication and donor site deformity rates were observed in patients undergoing autologous breast reconstruction using a slightly refined SGAP-flap technique. This technique may be considered as an acceptable alternative for DIEP-flap breast reconstructions.